Provider First Line Business Practice Location Address:
119 S BURROWES ST
Provider Second Line Business Practice Location Address:
SUITE #602
Provider Business Practice Location Address City Name:
STATE COLLEGE
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
16801-3894
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
814-360-0947
Provider Business Practice Location Address Fax Number:
814-238-1875
Provider Enumeration Date:
05/22/2007